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Focal epithelial hyperplasia in Abu Dhabi
Focal epithelial hyperplasia in Abu Dhabi M. B. Edwards, B.D.S, F.D.S.R.C.S., * and Ahmed Elballa Hamza, B.Ch.D., F.F.D.R.C.S.I.,** London, England, and Abu Dhabi MILITARY HOSPITAL, ABU DHABI Focal epithelial hyperplasia of the oral mucosa has not been described in the United Arab Emirates, and its incidence in the Middle East is sporadic. A typical case with a familial background was seen in Abu Dhabi in an I l-year-old girl.
I t is evident from a major epidemiologic survey I that the geographic distribution of the unusual lesion of oral mucosa termed focal epithelial hyperplasia extends beyond the confined groups of Amerindians and Eskimos in which it was first described. ~ Even so, outside of the Americas, its occurrence appears to be sporadic or poorly documented, and the disease is rarely seen in Caucasians, Asian Indians or Negroes. In the Middle East, cases have been reported in an Israeli family from North Africa, 3 in Egypt, 4 and in Iraq. 5 We have not found a formal description of the condition in subjects from the United Arab Emirates at the southern end of the Persian Gulf, and the case presented here may be unique. CASE REPORT An 11 -year-old girl was brought to the Dental Department of the Military Hospital in Abu Dhabi for treatment of numerous small, painless outgrowths on the oral mucosa. Her father said that the lesions had first been noticed 5 years previously and that recently two younger brothers had been affected similarly. On examination, much of the lower labial mucosa was found to be covered with both discrete and confluent, pink or faintly white plaques, some 3 to 5 mm. in diameter (Fig. 1). There were small, bilateral groups of identical plaques on the upper labial mucosa just anterior to the commissure, and a few lesions on the anterior margin of the tongue. No lesions were found on the skin. A dermatologist gave a clinical diagnosis of oral florid papillomatosis, and a biopsy specimen was taken from the upper lip.
Microscopic appearances The biopsy material (Fig. 2) contained several slightly elevated plaques of lightly parakeratinized, hyperplastic epithelium with branching processes, some of which had deep out*Research Fellow in Oral Pathology, Department of Dental Science, Royal College of Surgeons of England. **Consultant Oral Surgeon, Military Hospital, Abu Dhabi. 90'2
0030-4220/78/0645-0902500.30/0 ~) 1978 The C. V. Mosby Co.
Volume 45 Number 6
Focal epithelial hyperplasia in Abu Dhabi
903
Fig. I. Pale, confluent epithelial plaques on the labial mucosa and discrete lesions on the anterior margin of the tongue.
Fig. 2. Microscopic features of part of a single plaque, Parakeratinized epithelium is hyperplastic, with anastomosing and branching processes. (Hematoxylin and eosin stain. Magnification, • 72.)
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Edwards and Hamza
Oral Surg. June, 1978
growths parallel to the epithelial sur~'hce. Occasional enlarged and vacuolated cells were found in the middle to upper spinous layer. The basal layer was orderly and contained occasional mitotic figures. The lamina propria was slightly inflamed. The appearances were compatible with focal epithelial hyperplasia. DISCUSSION
In every respect, this case is typical of focal epithelial hyperplasia in a florid form. There was a reported history of familial transmission which is not uncommon, as the condition may be a communicable disease o f viral origin. 6 The novel finding of this case extends the boundaries of sporadic distribution of the disease in the Middle East, where it occurs in persons of mixed ethnic stock. It is likely that many cases remain undetected in regions where medical services are incomplete, because the condition is associated with neglible constitutional disturbances and does not invite attention. W e suspect that it was the possible social stigma of the disease in a girl approaching marriageable age which brought her to the hospital. In addition, the disease may be mistakenly assigned to the ill-defined category of florid oral papillomatosis, but biopsy will usually confirm the more precise diagnosis of focal epithelial hyperplasia. Careful documentation of cases o f multiple oral papillomas is recommended to promote the study o f this interesting condition. REFERENCES
1. Praetorius-Clausen, F.: Geographical Aspects of Oral Focal Epithelial Hyperplasia, PATHOL.MICRO,IOL. 39: 204-213, 1973. 2. Archard, H. O., Heck, J. W., and Stanley, H. R.: Focal Epithelial Hyperplasia: An Unusual Oral Mucosal Lesion Found in Indian Children, ORALSUR~. 20: 201-212, 1965. 3. Buchner, A., and Mass, E.: Focal Epithelial Hyperplasia in an Israeli Family, ORALSUR~. 36:507-51 l, 1973. 4. EI-Khashab, M. M., and Abd-EI-Aziz, A. M.: Focal Epithelial Hyperplasia (Heck's Disease), ORALSURG. 31: 637-646, 1971. 5. Perriman, A., and Uthman, A.; Focal Epithelial Hyperplasia; Report of Seven Cases From kaq, ORALSURG. 31: 221-225, 1971. 6. Van Wyk, C. W., Staz, J., and Farman, A. G.: Focal Epithelial Hyperplasia in a Group of South Africans: Its Clinical and Microscopic Features, J. Oral Pathol. 6: 1-13, 1977. Reprint requests to:
Dr. M. B. Edwards Department of Dental Science Royal College of Surgeons of England 35/43, Lincoln's Inn Fields London, WC2A 3PN, England
I t is evident from a major epidemiologic survey I that the geographic distribution of the unusual lesion of oral mucosa termed focal epithelial hyperplasia extends beyond the confined groups of Amerindians and Eskimos in which it was first described. ~ Even so, outside of the Americas, its occurrence appears to be sporadic or poorly documented, and the disease is rarely seen in Caucasians, Asian Indians or Negroes. In the Middle East, cases have been reported in an Israeli family from North Africa, 3 in Egypt, 4 and in Iraq. 5 We have not found a formal description of the condition in subjects from the United Arab Emirates at the southern end of the Persian Gulf, and the case presented here may be unique. CASE REPORT An 11 -year-old girl was brought to the Dental Department of the Military Hospital in Abu Dhabi for treatment of numerous small, painless outgrowths on the oral mucosa. Her father said that the lesions had first been noticed 5 years previously and that recently two younger brothers had been affected similarly. On examination, much of the lower labial mucosa was found to be covered with both discrete and confluent, pink or faintly white plaques, some 3 to 5 mm. in diameter (Fig. 1). There were small, bilateral groups of identical plaques on the upper labial mucosa just anterior to the commissure, and a few lesions on the anterior margin of the tongue. No lesions were found on the skin. A dermatologist gave a clinical diagnosis of oral florid papillomatosis, and a biopsy specimen was taken from the upper lip.
Microscopic appearances The biopsy material (Fig. 2) contained several slightly elevated plaques of lightly parakeratinized, hyperplastic epithelium with branching processes, some of which had deep out*Research Fellow in Oral Pathology, Department of Dental Science, Royal College of Surgeons of England. **Consultant Oral Surgeon, Military Hospital, Abu Dhabi. 90'2
0030-4220/78/0645-0902500.30/0 ~) 1978 The C. V. Mosby Co.
Volume 45 Number 6
Focal epithelial hyperplasia in Abu Dhabi
903
Fig. I. Pale, confluent epithelial plaques on the labial mucosa and discrete lesions on the anterior margin of the tongue.
Fig. 2. Microscopic features of part of a single plaque, Parakeratinized epithelium is hyperplastic, with anastomosing and branching processes. (Hematoxylin and eosin stain. Magnification, • 72.)
904
Edwards and Hamza
Oral Surg. June, 1978
growths parallel to the epithelial sur~'hce. Occasional enlarged and vacuolated cells were found in the middle to upper spinous layer. The basal layer was orderly and contained occasional mitotic figures. The lamina propria was slightly inflamed. The appearances were compatible with focal epithelial hyperplasia. DISCUSSION
In every respect, this case is typical of focal epithelial hyperplasia in a florid form. There was a reported history of familial transmission which is not uncommon, as the condition may be a communicable disease o f viral origin. 6 The novel finding of this case extends the boundaries of sporadic distribution of the disease in the Middle East, where it occurs in persons of mixed ethnic stock. It is likely that many cases remain undetected in regions where medical services are incomplete, because the condition is associated with neglible constitutional disturbances and does not invite attention. W e suspect that it was the possible social stigma of the disease in a girl approaching marriageable age which brought her to the hospital. In addition, the disease may be mistakenly assigned to the ill-defined category of florid oral papillomatosis, but biopsy will usually confirm the more precise diagnosis of focal epithelial hyperplasia. Careful documentation of cases o f multiple oral papillomas is recommended to promote the study o f this interesting condition. REFERENCES
1. Praetorius-Clausen, F.: Geographical Aspects of Oral Focal Epithelial Hyperplasia, PATHOL.MICRO,IOL. 39: 204-213, 1973. 2. Archard, H. O., Heck, J. W., and Stanley, H. R.: Focal Epithelial Hyperplasia: An Unusual Oral Mucosal Lesion Found in Indian Children, ORALSUR~. 20: 201-212, 1965. 3. Buchner, A., and Mass, E.: Focal Epithelial Hyperplasia in an Israeli Family, ORALSUR~. 36:507-51 l, 1973. 4. EI-Khashab, M. M., and Abd-EI-Aziz, A. M.: Focal Epithelial Hyperplasia (Heck's Disease), ORALSURG. 31: 637-646, 1971. 5. Perriman, A., and Uthman, A.; Focal Epithelial Hyperplasia; Report of Seven Cases From kaq, ORALSURG. 31: 221-225, 1971. 6. Van Wyk, C. W., Staz, J., and Farman, A. G.: Focal Epithelial Hyperplasia in a Group of South Africans: Its Clinical and Microscopic Features, J. Oral Pathol. 6: 1-13, 1977. Reprint requests to:
Dr. M. B. Edwards Department of Dental Science Royal College of Surgeons of England 35/43, Lincoln's Inn Fields London, WC2A 3PN, England